CMS Signature Requirements Allow No Abstract Art Exclusion For Doctors.

My doctor signature is but a shell of its former life.  Like a homeless drug addict, the lines wander aimlessly, permanently confused and disoriented.    This is what my doctor signature has become.  It's nothing but abstract art.   Unfortunately, the Centers for Medicare and Medicaid Services (CMS) provides no abstract art exception to their signature requirements.

How did my doctor signature come to this?  Was it a subconscious attempt to fight against the machine?  Nah.  It was my tired and aching fingers after writing tens of thousands of required  signatures over the year.  Each year the name became shorter and less legible.  The first and last name morphed into squiggly marks known only to those with a keen eye for paying attention.   "Who wrote that note", the nurses say.  "Why, that's Dr Happy's signature, of course", they respond.

My CMS signature is now nothing more than a single stroke.  It is a first and last name combined into that beastly mess seen below.   I am not proud of myself by any means, except to say at least I'm not one of those people at the grocery store that signs their check with their first, middle and last name, in calligraphy,  while twenty people wait patiently to get home to their families.  Seriously people.  Is that really necessary?  Who uses checks these days anyway?

How do I get away with such a ghastly signature?  How does Medicare allow physicians to get paid for their illegible scribbles known only to a select few nurses with dedicated handwriting deciphering skills?  I'm glad you asked.  In fact, Medicare actually has very detailed rules to stay in compliance with Medicare signature requirements.  Here is the link to the official August, 2012 Medicare Learning Network publication detailing the rules.  I have summarized the requirements below for quick review.
  • What is required for a valid signature by CMS?
    • Services that are provided or ordered must be authenticated by the ordering practitioner
    • Signatures are handwritten or electronic (stamped signatures are not acceptable).  Several exceptions are detailed here, including facsimiles of original written or electronic signatures to certify terminal illness for hospice.  
    • Signatures are legible.
  • What if the signature is not legible?
    • The physician may submit a signature log or attestation statement to support their identity.  If a printed signature is present below the illegible signature, that may be accepted
  • Are electronic signatures allowed for CMS requirements
    • Yes.  
Make sure to click on the links above to read further details regarding signature logs, attestation statements and electronic signature requirements.  CMS also has more information regarding signature requirements in transmittal 327 with regards to change request document CR 6698 published March 16th, 2010.  You can review and download that pdf document here for files.  Among other things, the document explains date of service documentation requirements, reviews electronic prescribing, contains a nice example of a signature attestation statement and provides clinical situations where the signature should and should not be accepted by Medicare review contractors.  

I wonder if any review contractors have ever opened up their own physician signature abstract art gallery.  I bet it would be neat to see all the examples of illegible signatures from all parts of this country.  If physicians can't get paid for the work they have provided because their poor handwriting, maybe they can collect royalty payments for their abstract art!  For example, I love this progress note written by a physician and signed off on by an APRN.  Ah, the future of medicine is here and it's not pretty, but it is abstract...

Bad writing doctor progress note humor photo

"I took a special class on deciphering physician handwriting and learned one critical lesson:"

Physician handwriting ecard humor photo

Some of this post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession.  This original Happy Hospitalist ecard is part of a complete collection of crude medical humor on Pinterest.  Read at your own risk.

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6 Outbursts:

  1. A long time ago, in a galaxy far away, I used to work for a great big bureaucracy. In fact, the biggest one in the world. Anyway, I developed the ability to duplicate the signature of the highest ranking bureaucrat in the building where I worked. His secretary found that extremely handy when he was not available, which was often the case, and she needed something signed.

    Of course, I, being in the typist pool, had great fun creating and typing up memos on bureaucracy stationery, and then signing them. I once sent a memo to some of the men instructing them not to spend so much time "flirting" with the typists. It was very effective.

    Back before there were sexual harassment laws, I found ways to deal with it.

    Are you worried about patients working on duplicating your sig?

  2. AH HA!!! I know who you are now. You work at my hospital!

  3. I'm a teacher and the same thing has happened to my signature. My students remind me frequently how easy it is to forge.

  4. Irish RN, actually you work at my hospital.

    Just kidding.

  5. Haha, I love this post. My signature, after 2 years of putting my signature on 50000000 papers has become the first letter of my first name followed by a scribble. The sad part is that my EMS staff and the ER staff can all read it. I guess we're all so used to the scribble sig.

  6. Just curious, are your progress notes equally as well defined as your signature? ;P


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